Healthcare Provider Details

I. General information

NPI: 1215612999
Provider Name (Legal Business Name): VIANKA CONCEPCION MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

V. Phone/Fax

Practice location:
  • Phone: 844-344-4453
  • Fax: 844-344-4453
Mailing address:
  • Phone: 844-344-4453
  • Fax: 844-344-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: